Unhealthy and Unworried

If you are reading this editorial, then there is a good chance that you already know quite a bit about diabetes. If you're reading this and happen to have diabetes yourself, you're almost certainly aware of it. But millions of Americans with diabetes or prediabetes are not aware of their condition. And this is no longer just an issue in the United States. Rates of diabetes in Asia and the rest of the world are catching up, which means that rates of undiagnosed diabetes are also on the rise.

A couple of years ago, the American Diabetes Association gave health care providers an important tool in our effort to identify diabetes early by endorsing the use of A1C for screening. Patients no longer need to come in to the office fasting or be kept in the office for two hours for glucose challenge testing. An A1C test can be done at any time; a value of 5.7 to 6.4 percent identifies prediabetes, and 6.5 percent or greater indicates diabetes. But a persistent barrier to effective screening often remains the willingness of people who are at high risk for diabetes to be screened. And that is where we can all play a role.

Informed, nonprofessional caregivers play an important part in the health and well-being of people with diabetes. Simply put, family and friends matter a lot. Their help can also be especially valuable in encouraging high-risk people to be screened. We health care professionals cannot screen people we are not seeing, and too often our screening efforts catch what we call the "healthy worried."

It's often the healthy worried who take advantage of health care services when they are made available—not those who would benefit the most. In other words, the people who carry the greatest risk for diabetes or other chronic diseases are often the ones least likely to do something about it.

We see the healthy-worried effect all the time at health fairs. The lines for cholesterol and blood glucose testing are filled with people stopping by in their jogging outfits and carrying bottles of water, while out-of-shape people toting big, sugary drinks pass on by. Those who work in public health often joke ruefully that men seek medical care only when they're impotent or think they might be dying. Otherwise, we men mostly let things slide.

But letting undiagnosed diabetes slide is harmful and dangerous. So if you have an unhealthy, unworried person in your life, remind him or her how easy it now is to get a diabetes screening test. It's accurate and doesn't require spending hours at the doctor's office or showing up on an empty stomach. And think of how much good you will have done for someone who gets diabetes diagnosed two, three, or five years earlier than otherwise would have happened, perhaps staving off serious complications.

Personally, I have a cousin in mind who will get a little extra visit at the next family picnic.